title: Prevalence of and factors associated with head impact during falls in older adults in long-term care.
abstract: BACKGROUND
  Falls cause more than 60% of head injuries in older adults. Lack of objective evidence on the circumstances of these events is a barrier to prevention. We analyzed video footage to determine the frequency of and risk factors for head impact during falls in older adults in 2 long-term care facilities.
  
  
  METHODS
  Over 39 months, we captured on video 227 falls involving 133 residents. We used a validated questionnaire to analyze the mechanisms of each fall. We then examined whether the probability for head impact was associated with upper-limb protective responses (hand impact) and fall direction.
  
  
  RESULTS
  Head impact occurred in 37% of falls, usually onto a vinyl or linoleum floor. Hand impact occurred in 74% of falls but had no significant effect on the probability of head impact (p = 0.3). An increased probability of head impact was associated with a forward initial fall direction, compared with backward falls (odds ratio [OR] 2.7, 95% confidence interval [CI] 1.3-5.9) or sideways falls (OR 2.8, 95% CI 1.2-6.3). In 36% of sideways falls, residents rotated to land backwards, which reduced the probability of head impact (OR 0.2, 95% CI 0.04-0.8).
  
  
  CONCLUSIONS
  Head impact was common in observed falls in older adults living in long-term care facilities, particularly in forward falls. Backward rotation during descent appeared to be protective, but hand impact was not. Attention to upper-limb strength and teaching rotational falling techniques (as in martial arts training) may reduce fall-related head injuries in older adults.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Schonnop
authors.forename: Yijian
authors.initials: Y
authors.lastname: Yang
authors.forename: Fabio
authors.initials: F
authors.lastname: Feldman
authors.forename: Erin
authors.initials: E
authors.lastname: Robinson
authors.forename: Marie
authors.initials: M
authors.lastname: Loughin
authors.forename: Stephen N
authors.initials: SN
authors.lastname: Robinovitch
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data*; D000368:Aged; D001955:British Columbia / Q000453:epidemiology; D006259:Craniocerebral Trauma / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D008134:Long-Term Care; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D011795:Surveys and Questionnaires